By Eric J. Keller, MA, M4, Feinberg School of Medicine Northwestern University

Both within and outside of healthcare, there is a general sense that an internist is different than a surgeon. Despite both being physicians, we understand that certain personality types tend to be attracted to certain specialties, and their distinct training pathways seem to reinforce or foster certain interests and values. Specialties truly are distinct cultures with unique terminology, tools, idols, journals, societies, meetings, training, and often work spaces; yet, exactly how these cultures differ and how this affects patient care is largely underappreciated and studied.

Over the last 3 years with the help of mentors like Robert Vogelzang, MD, FSIR, I have tried to shed some light on how specialty tribalism affects treatment of symptomatic uterine fibroids, endovascular stenting, and cardiovascular imaging. This work led us to also question how certain professional values develop during training, a process that the medical education community has termed “professional identity formation.” Here current literature is also sparse especially in regards to how specific values are cultivated in each specialty. The recent establishment of interventional radiology (IR) as a primary specialty is a unique opportunity to study this process both at an individual and specialty-wide level. How does a new specialty shape its professional identity and change how other clinicians perceive that group? There’s quite a bit of interesting historical context to inform this question, but suffice it to say that the task is rarely easy and without controversy.

To try to understand the current IR professional identity, we interviewed 16 fellows across 4 programs at the beginning and soon after their fellowship. We asked them about their educational journey, recent patient interactions, and views of IR and other specialties. These interviews were then systematically analyzed using a well-validated method from anthropology called constructivist grounded theory. This allowed us to identify central themes and make some interesting conclusions:

Are you a radiological surgeon or surgical radiologist? Fellows consistently described one of two educational journeys. The majority (62%) had planned on being surgeons but were turned off by the lifestyle, procedure length, and/or personalities leading them to IR – radiological surgeons. The others (38%) were the biomedical engineer/computer science majors that loved technology and diagnostic radiology but wanted to do more procedures or have more patient contact – surgical radiologists. Interestingly, this division also predicted their perceptions of their training and the type of IR position they pursued after training.

What does it mean to be a “more clinical” IR? Despite a consensus that the field needs to be “more clinical,” this idea was loosely defined. Often it was described in terms of informed consent, comfort during the procedure, and some degree of short-term follow up. For some this seemed economically motivated while other described this transition in terms of “taking responsibility for procedures.”

What makes a good IR? Fellows and attendings consistently emphasized values common among surgical fields and radiology rather than interests emphasized by specialties like internal medicine. Common values included breadth of knowledge, thinking on one’s feet/outside the box, innovation, technical skill, working hard, fixing problems, and adapting/advertising skills to referring providers.

Please check out the full paper here as well as the thoughtful commentary on the work written by Jeanne M. LaBerge, MD. I would love to get your feedback and help sharing these questions with others.

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